Mandatory Mental Health Education

Lately I’ve been spending a lot of time talking to people about concrete ways to deal with stress or improve their mental health. It’s been really interesting and kind of exhilarating as I notice how much I’ve learned in the last year or so and how wonderful it is to be able to share with others. However as I do this, I’ve begun to notice that even those people who are supposedly “normal” often don’t have a whole lot of skills around managing their mental health. Many of them have struggled to regulate emotions, to understand interpersonal effectiveness, or to tolerate distress. While they likely don’t feel emotions as strongly or have as few skills as those with diagnoses or who have been medicated, there is almost no one in this world who is an expert in navigating their emotions and mental health. To use the featured pic as an example, while not everyone is hanging out in the burning basement, few people are on the roof and everyone could enjoy being a few steps higher on the ladder.

 

The odd thing about understanding emotions is that it’s something we’re never taught. We are taught how to interact with other people, we are taught how to learn, we are taught how to budget or do our laundry or care for an animal. We’re particularly taught how to take care of our physical health. But for some reason everyone is expected to just pick up how to manage emotions and mental health. Now many of us have things modeled for us by our parents, but they were often just as clueless as we were and have cobbled something together out of their life experiences to get the best version they can. And rarely do they spend a lot of time consciously helping us sort out our emotions. All of that seems a little bit ridiculous to me. If there are two things that are really really useful to be successful anywhere else in life it’s stable mental health and stable physical health. If you don’t have those two things, everything becomes infinitely more difficult. So why don’t we give our children the tools to succeed?

 

Especially as I’ve been participating in DBT, I’ve been noticing that it really would not be all that hard to include education like that in schools. I only go once a week for two and a half hours. And I’m supposed to figure these skills out in a year. If we began implementing some of the knowledge that we have from psychology in schools from the time children start and teach them skills that will actually help them regulate emotions and deal with interpersonal relationships, we wouldn’t have to devote much time each week to it. Think of how helpful it would be to kids to understand what being judgmental is and how to cut down on judgments without feeling ashamed or bad about it. Or how helpful it would be to give them clear strategies for calming themselves. Or to help them recognize and name their emotions. Or to learn that emotions are acceptable and that they can feel emotions and simply sit with them. Holy cow I would have done so much better in life if I had had some of this basic training.

 

I don’t know if there’s any way to make this happen, but if we could adjust education in any way, I would suggest that we should add in a basic curriculum of emotional regulation. Most schools have a school therapist: it could be something they do once a week or once a month, or it could be something that teachers start getting trained on in school. It would include skills like how to make requests, set boundaries, validate, or be generous to and with others as part of interpersonal effectiveness. It would include techniques like breathing, distraction, or self-soothing for tolerating bad situations. And it would include some measure of work on identifying emotions, accepting emotions, fighting judgments, and using mindfulness to accept situations. Does anyone have a suggestion of how to make this into a petition or move it into the broader dialogue? I never hear a question of emotional education being brought up when we talk about improving mental health, but this could be a huge step towards decreasing stigma and increasing access.

How To Read a Stream of Consciousness Book

My boyfriend and I have very different reading styles. When he reads, he likes to understand every bit of the book. He’s more deliberate than I am: he tries to pick apart every piece of the syntax, understand every allusion, get every symbol. I on the other hand, read quickly. I don’t spend a lot of time while I’m reading doing analyzing. I let the book wash over me. I get engrossed in plots and characters and a different time or place. I escape into my books. When I emerge, I dust myself off and think about what just happened.

 

This means that we’re suited to different types of books. My boyfriend is stellar at reading straightforward books, books like The Great Gatsby that are full of symbols and meaning but that follow a relatively linear path. I on the other hand can feed on stream of consciousness novels, things that wend different perspectives together, things that don’t quite make sense until you experience them. And so for those individuals who tend to be more analytical about their reading, let me offer some advice for reading a stream of consciousness book.

 

1.Don’t try to make sense of it. Just let it happen to you.

This can be really hard for some people. They may want to go back over and over a section until they have understood what happened in it. I often find that it’s more useful to just get a feel of something that makes no sense and then read onwards. Things are explained later. Things come to light with more information. You can always come back later. But what’s important isn’t always the specific words: it’s the mood. When you come back to analyze later you can try to figure out what created the mood, but in the instant, you need to let your brain happen in synch with the book.

 

2.Don’t try too hard to focus. Let your mind wander.

This was especially true of James Joyce for me, which is not stream of consciousness but is certainly not linear. Oftentimes stream of consciousness or non linear books don’t have a clear one to one connection between their allusions or symbols and the meaning of those allusions or symbols. They cast a wide net. You have to let your mind be open to all of the associations you feel for the images and ideas that are presented. Again, there is a kind of resonance that can happen between your mind and the novel. You may not imagine or feel the same pictures and feelings that the book presents, but your mind might throw up your version of those pictures and feelings. For example when I was reading 13 Reasons Why, instead of seeing the events as Hannah described them, my mind threw up my own experiences of depression and the images that I associated with it. It allowed me to inhabit the character through my own experience. This is often true when you get allusions, as your associations might not be exactly the same as the author’s.

 

3.Read in long stretches.

When I read a stream of consciousness style book I usually read it all in one go. This is generally not by choice, as I usually forget who I am and what I was doing until I finish the book and mourn the loss of whoever I was for those hours. But for those who have a harder time with reading things straight through, at least make sure you dedicate fair chunks of time to a book that’s about mood and feeling. This isn’t the kind of book to have on your bedside table to read a few pages before bed. This is the kind of book you take to a coffee shop and immerse yourself in. Generally these books are in the first person, and it takes a little bit to let yourself fall into character; because that’s the idea: to become the character for a time.

 

4.Analyze afterwards.

Some people like to do a lot of analysis while they’re reading. They write notes in the margins, they try and pick apart the novel as they read it. They get a lot more out of their first read than I ever could. But when you’re trying to enter someone’s stream of consciousness, you can’t be analyzing at a meta level while also inhabiting the experience. You can always come back later and consider the symbols and the themes and the characters. You can underline or star or mark the pages that seem important to you as you’re going. But let yourself be the character while you’re reading instead of trying to be the observer who figures things out.

DSM V and Diagnostic Woes

THE NEW DSM IS OUT AND I HAVE A COPY OF IT! For those who don’t know, the DSM is the Diagnostic and Statistical Manual, essentially the bible of Psychology. It’s what’s most often used to diagnose someone, and if you want insurance to cover treatment you generally need a DSM diagnosis. They’ve been in the midst of some pretty contentious updates for a long time, but I now have my hands on the brand new copy of the DSM-V.  Mmmm, tasty.

 

Of course when I got ahold of it I spent a good half an hour paging through and self-diagnosing, but after that diversion, I moved over to the eating disorder section to see what updates had actually gotten through and how they had phrased them. I was happy to see the inclusion of Binge Eating Disorder, as well as Night Eating Disorder and Purging Disorder as new categories in the manual, but when I looked back at our old favorite anorexia I was…annoyed.

 

One of the most contentious points in the DSM IV was the weight criterion for anorexia. While this has been removed from the current version and replaced with the following: “a significantly low body weight in the context of age, sex, developmental trajectory and physical health. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected,” there is a scale to determine the severity of the disorder. This scale is entirely based on BMI, with the caveat that a psychologist can make adjustments if necessary. And I must say that the numbers listed on that scale are INSANE. To be considered a moderate case, your BMI needs to be between 16 and 17.  My BMI has never been even close to that. While I generally dislike numbers, and I am going to insert a HUGE TRIGGER WARNING right here, when I was at my worst I literally would go for a week without eating at times. I never ate two days in a row. I was seriously ill. However my body weight never dropped into what would be considered technically underweight by the BMI scale. I would have been considered a mild case, even if I had gained the diagnosis at all (as it stands I was diagnosed with EDNOS because of the weight criterion in the DSM IV).

 

We have gone over and over the harms that come from including weight as a criterion of an eating disorder. First and foremost, it keeps people from getting treatment until they’re already too sick, which is unhelpful to everyone involved. It ignores how different bodies react to starvation. It ignores that people’s weight can fluctuate throughout the disorder or treatment. It’s simply unrealistic. But more than anything, I feel like it shames those people who never get that diagnosis. It tells them that their pain and suffering wasn’t real unless they hit the magical BMI of 17 marker. And I am so disappointed in the writers of the DSM that they would ignore all of the feedback they’ve received from the eating disorder community and still include BMI criteria for anorexia. I’m so disappointed that after all the research and stories and experiences that people have shared that illustrate that an eating disorder is not about weight, we still have to reduce to such. And most of all I’m disappointed that until the next rewrite, more individuals will be stuck trying to navigate a system that reduces them to their weight, even as it’s trying to convince them that they should stop doing that.

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Thoughtfulness, Tragedy, and Autonomy

A few weeks ago I wrote about some of the rhetoric that we use around women’s rights and their autonomy in terms of their own bodies. In particular, I focused on women’s health, and how the dialogue around women’s health tended to have two modes: “this is serious, debilitating, and tragic” or “A WOMAN DID SOMETHING WITH HER OWN BODY WOOHOO!” I believe that this type of dichotomy exists in all sorts of places in women’s lives, and that it doesn’t do women any good. When we are talking about women’s lives, almost nothing exists in the black and white places of life. More often than not, there is a dialectic. Something can be empowering and good while also being thoughtful or difficult. To look at a particular example from my own life: my attempts at recovering from an eating disorder are clearly a form of taking my own empowerment in hand and standing up to many of the expectations of women in my life. However at the same time it is something that comes with a great deal of pain, a great deal of stress and anguish and difficulty, and a great deal of thought and reflection. Most of the empowering things in our lives come only after deliberation and reflection.

 

Because of the role of oppression in women’s lives, we need to be extremely careful about understanding how the personal and the communal interplay in any individual decision that a woman makes. For example, I am all for applauding when a woman exercises her rights over her body, but having some empathy for the fact that it might have been a hard or confusing or thought-filled decision is probably a good idea. Societally, when a woman takes control of her own body and does something like have an abortion or have a mastectomy, she is helping to break down patriarchal values and oppression for everyone around her, including herself. However personally, these may be decisions that required some thought, that were painful or uncomfortable, or that just were not fun. We are allowed to both praise something and show sympathy for whatever toll it might have taken on the individual who enacted it.

 

Having empathy about the experiences that women go through while they are exercising their rights allows us to hear the individual experiences, something that has always been hugely important to the women’s movement. We cannot try to improve women’s experiences unless we actually take the time to hear what those experiences are.

 

Particularly in the realm of women’s health, we can both applaud someone for the fact that they have done something bold in their personal choices, while also recognizing that most health decisions and procedures come with some price and that we should be aware of that. We should recognize and celebrate that women go through complex thought processes surrounding their mental health. We should make it HARD for conservatives to view us as stupid little womens who don’t know anything about their own health and who just frivolously run around cutting pieces of ourselves off. We should respect each other enough to make thoughtfulness (without tragedy) part of the dialogue about women’s health. It’s something that is often missing. More often we hear about morality, or about rights, or about access, or about money. Rarely do we stop and listen to deliberations that women have to go through in order to make their healthcare decisions, particularly when they are in oppressive situations that limit their access. When thoughtfulness does come into the dialogue, it’s often as a way of casting women’s healthcare and health choices as something tragic, difficult, or heartbreaking in a way that men’s health is not (few people talk about how thought-filled the decision to get a vasectomy is, despite the fact that people probably put a great deal of thought into it).

 

Indeed the idea that “thoughtful” necessarily means difficult is simply wrong and unhelpful. We are thoughtful about many things. Sometimes they’re difficult and also positive (deciding where to go to college), sometimes they’re difficult and heartbreaking (whether to pull the plug on a dying relative) sometimes they’re not difficult at all and they’re just great (like trying to decide which flavor of cupcake to buy…that takes a lot of thought let me tell you) and sometimes they’re not difficult but they kind of suck anyway (like choosing to get a pap smear, which I always think about and always know what I’m going to answer and always hate the answer to anyway). We think about all kinds of things and we make decisions based on thought processes all the time. Saying that something requires thought or reflection doesn’t necessarily mean that we don’t know what we’re going to answer or that it will hurt us or that it will have a negative consequence. It just means we wanted to make sure it was the right decision.

 

We need to create space for the ways that women actively navigate their lives, and the balance that they must constantly keep between their personal needs, their personal decision making, and the societal pressures around them. We need to keep in mind that while a woman might have really loved getting that abortion because it was exactly the right thing in her life, there are social repercussions and we should be empathetic to that. We need to keep in mind all the sacrifices that women make nearly every time they make a choice about how to exercise their autonomy. And the more we do this, the less we will have black and white thinking and dichotomies, and the more we will have a conscientious dialogue with other women about how frustrating it is to navigate the world we live in, in which there are almost no “right” choices, only better choices. I think that definitionally, as women, nearly every decision we make has to be thoughtful (obviously there are some exceptions, but when you’re part of an oppressed group you’re forced to be more conscious of your decisions). And because of this, we are always aware of the costs and the benefits of our decisions. Now we need to start recognizing that process in others.

Clean House Clean Mind

This weekend I’ve been helping my boyfriend deep clean his bedroom, send a lot of things off to the Goodwill and a lot off to the dump, and generally try to start with a fresh slate in terms of stuff. It’s interesting because it’s been a fairly emotional process for both of us. I’m not entirely sure why we as human beings feel such an attachment to possessions, but one thing that is certain is that a large part of cleaning house involves looking at who you have been and where you have gone, and making decisions about where you want to go in  he form of asking “Will I ever use this again?” or “Is this important to me?”

As we answer these questions, we decide which futures still seem possible to us. Each time you look at an object and decide whether you will need it, you’re deciding whether it’s part of the future you want, and with it, all the possibilities that it represents. When you throw away the sushi kit you never used, you have to abandon the small part of you that still dreams of being a sushi chef. And while you do it, you also have to recognize the things you’ve failed to do, the things you’ve failed to accomplish: you never used it. You never pursued that dream. Things didn’t work out the way you intended when you purchased it and imagined rolling out your homemade sushi.

None of us like to cut off futures. None of us like to close doors. Unfortunately, when we’re  cleaning, we don’t get to see the new doors that we’ve made space to open. Each of those things that you’re holding on to is taking some amount of your attention, some amount of your energy, and when you consciously choose to move on from it, you’re freeing up mind space and physical space that can be used for something new, something that you’re passionate about now, something you will actually love and move forward with. The difficult part of cleaning house is that you don’t get to see that particular pay off. All you see is your past walking out the door.

Because of the link between objects, emotions, and futures, cleaning house can be a practice in cleaning your mind. You remove the rubble, the things that you were holding on to and thinking of and worrying over, and try to let them go.

An important element of this is the reminders. Objects are firm reminders of the past. You see pieces of who you used to be, dreams and identities you used to have, past relationships, past careers. All of these are difficult to be reminded of, and can trigger you to reprocess the memories and the events. The objects you chose to keep can symbolize a lot about how you felt towards a particular event or person. Choosing to remove those reminders can feel like giving up on the past or losing your connection to your past, and even more potent, looking at your past laid out in front of you can be a really difficult moment of self-evaluation. All of us have disappointments, whether it be looking at the guitar we gave up playing, or finding a letter from the lover we thought we’d marry, and when you see the objects from past years strewn out in front of you it’s incredibly difficult to not feel like you haven’t done enough or you haven’t done well enough, like you’ve stagnated, like you’ve disappointed others and yourself.

In reality, these physical reminders are often just reminders of the bad things. We don’t notice the diploma we already have hanging up, or the books we’ve read and replaced on the bookshelf, or the career that we now have. And while we might feel bad about removing the reminders of the bad things, we can’t escape the past no matter how hard we try. It shapes who we are. When we choose to remove reminders, we free up mental and emotional space that can be used for the here and now. It can literally give your brain the space to begin rewiring for new identities, thoughts, priorities, and actions. And it gives you the literal, physical space to grow again: you can begin new projects, you can feel comfortable enough to start something in your apartment, or to dance, or to work out. Giving yourself literal space to move around in can absolutely make you feel mentally more comfortable.

Choosing to make changes like removing detritus or purging your things is always difficult. It means accepting that certain things in your life are over, letting go of who you were, accepting that your life has changed. It can also mean accepting lost opportunities. But on the plus side, accepting all of these things is the first step towards changing and growing. It’s an odd paradox, but the first step towards change is radical acceptance of what is, because you have to accurately see the current situation before you can change it.

I think perhaps the best part of practicing cleanliness and simplicity in your home and your things is that it can help you to live in the present. When you are living in the present, the only pain you feel is the pain of the moment. You’re not thinking of the futures that could be, and you’re not thinking of the past and what hurt you then. The future and the past contain a great deal more pain than this moment right now, and when you recognize that and only reside in the present, you liberate yourself of a great deal of pain.

I have always believed in the importance of limiting how much STUFF I hold on to. I think that having enough things to tie you down and make you feel solid, as if you have a real identity and have chosen which memories to keep, can be extremely beneficial to feeling certain of who you are. But like any practice of emotional balancing, it’s important to consistently clear out the remnants that you don’t want, so that you can feel solid without being weighed down.

Things are often more metaphorical than we realize. It can be good to think of what they’re representing for us.

Roundup of Posts

Yesterday I had a slow day posting here but that’s because I was busy elsewhere! Check it:

At Teen Skepchick I posted about in person vs online activism and focuses. Hint: I like both.

At CFI On Campus I made some comments about the different priorities of the skeptical movement. I’ll let you all guess where I fall on that debate.

And just because I love you guys I’m even going to send out a few other links I’ve liked this week. Today there was a great post about stigma in the workplace towards mental illness. Miri’s got a fantabulous post up with a really interesting metaphor about when it’s pertinent to talk about gender.

So enjoy your long weekend my pretties and read away!